Based on data from the Helsinki stroke registry, this paper described interventions that collectively allowed a stroke center to reduce their door-to-treatment time to 28 minutes, with half of patients treated within 20 minutes! Some of the key interventions included:

EMS calls the ED stroke physician’s mobile phone directly

All orders are done and tPA is premixed while the patient is still in transport

Accucheck is done by the paramedics, and a POC INR done on arrival; they don’t necessarily wait for other labs

When the patient gets to the ED, they are transferred immediately onto the CT table (which is located in the ED) instead of an ER gurney. The stroke team is there, and the tPA bolus is given while they’re still on the table

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Cool, right? I feel like there is SO MUCH INEFFICIENCY in medicine, and it’s nice to see that sometimes little things, like skipping the ED bed step, can collectively make a big difference.